Provider Demographics
NPI:1033155031
Name:SUNDANCE TECHNOLOGIES AND TRAINING CENTER, LLC
Entity Type:Organization
Organization Name:SUNDANCE TECHNOLOGIES AND TRAINING CENTER, LLC
Other - Org Name:SUNDANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPAK
Authorized Official - Suffix:
Authorized Official - Credentials:LGC, BA, BS
Authorized Official - Phone:505-298-6440
Mailing Address - Street 1:PO BOX 11605
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87192-0605
Mailing Address - Country:US
Mailing Address - Phone:505-298-6440
Mailing Address - Fax:505-298-7502
Practice Address - Street 1:12300 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2557
Practice Address - Country:US
Practice Address - Phone:505-298-6440
Practice Address - Fax:505-298-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM61268246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty